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As epidemic rages, ER study finds opioids no better than Advil and Tylenol

arstechnica.com

81–90 of 161 posts

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#81

I don't get the US stance on opioids. In Germany they are heavily regulated and can't be obtained without special prescription giving them an rather exclusive aura. No German doctor would prescribe them for headaches and people only really get them after serious surgery for a really short term. Advil (Ibuprofen) and Aspirin (ASS) are far more common here and used for pain management at a far broader extent than in th…

"And frankly so, Germany doesn't have an opioid problem."

You are very uninformed obviously. As far as i know for my town, Paderborn (NRW), we have about 1.000 people receiving opioid replacement drugs under government supervision (~90.000 city population).

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#82
This is a highly misleading presentation of the study.

The study compared the following doses: — 400 mg ibuprofen and 1,000 mg acetaminophen — 5 mg oxycodone and 325 mg acetaminophen — 5 mg hydrocodone and 300 mg acetaminophen; or — 30 mg codeine and 300 mg acetaminophen

https://media.jamanetwork.com/news-item/no-significant-diffe...

So, the study is comparing high doses of ibuprofen/acetaminophen to low doses on opiates/acetaminophen.

It is an interesting outcome for mild pain and suggest that for mild pain it might be better to pass on low dose opiates but in no way does this show that opiates are not needed for severe pain.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#83

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

Same here. After a LONGGG phone call cradling the receiver while trying to type, etc., I had my neck spasm severely -- so much so that the following day someone else had to drive me to urgent care (1). They prescribed a strong muscle relaxant in combination with either Percocet or Vicadin -- I forget which.

I switched over to the default over the counter dose of ibuprofen, and it worked better than the combination of those two "heavy duty" prescription drugs.

I will say, though, that doctors in the U.S. have been damned cavalier about ibuprofen. One doctor with a popular radio show would cite the nickname, "Vitamin I", and routinely tell people to use it non-stop for a month or two.

I've found that now, a few days on it will make me rather lethargic. My cardio strength and sometimes rhythm feels impaired. And lo, there are studies now coming out that indicate it may carry as much risk as Vioxx and the like.

(Incidentally, a doctor prescribed me Vioxx a month or two before it was yanked from the market. I questioned this, remarking on recent news I'd read indicating it had problems. He had no clue and told me it was perfectly safe. Sure, it was still on the market, then, but he appeared to have no clue about the looming controversy.)

With any medicine, it really seems TANSTAAFL. You have to carefully weigh the benefit against known as well as suspected risks. And the U.S. medical system completely falls down in not fully informing not just patients but also doctors to the existence and nature of these.

1) Well, that urgent care experience -- a new facility opened by the premier area hospital -- was itself a horrible experience. Deserted facility, by all appearances, yet it took about 2.5 hours to see a doctor. Who gave me no neck brace; family took me to their chiropractor, the next day, who DID give me a neck brace -- which provided the first real relief and stopped me from constantly retriggering the injury with every movement.

To be clear, I refuse to have my neck cracked. And the chiropractor wouldn't have, at that point, anyway, given my severe spasming. But at least he had the sense to immobilize my neck. (Then he provided some ongoing care to encourage the release and healing of the spasming. To whatever extent this may have helped, that initial immobilization was key. WTF was wrong with that fully credentialed MD serving the urgent care's rather extensive ER facility?)

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#84
post #19

All the commenters thus far seem to think they know more than a randomized clinical trial that was double blinded looking at oral (not IV morphine) combination doses of opioids like codeine, hydrocodone, and oxycodone with tylenol vs ibuprofen+acetaminophen (tylenol). Here's the actual study if you would like to read more... https://jamanetwork.com/journals/jama/article-abstract/26615... I'd like to note that their p…

Yup -- requesting an edit of the link title to clarify that it's about oral analgesics only, not IV analgesics, since this has indeed been a major point of confusion for several commenters.

To clarify even more, it also doesn't address cutaneous delivery of opioids or other analgesics for people who are unable to take either IV or oral applications.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#85
post #80

Earlier quoted context omitted.

Cannabis has pretty awful side-effects for me. It gives me absolutely incredible nausea, to the point where I've tried it ~10 times in varying doses, thinking my dosage was an issue, and out of those I was violently ill 4 of the times. The other 6 times were simply unenjoyable. It doesn't just go away like alcohol either. If I drink too much and throw up, I feel better within a few minutes. For cannabis I remain high…

I am not sure you actually had just Cannabis if you had those symptoms. Was this at some legal location with a proven supply chain? PS: Not to defend Cannabis, it can trigger Heart Attacks and is associated with a host of Lung issues. I just never heard of those symptoms.

Yep! I tried edibles, joints, and vape pens from 3 different dispensaries in the bay area. The edibles and "free" joint I got from Airfield Supply Co. were the ones that effected me the least negatively.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#86

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

NSAIDS are not benign. Digestive problems are so common with long-term use that some doctors think that they should co-prescribed with omeprazole and other agents to head them off. (Long-term omepraloze will give you B-12 deficiency if you don't supplement; it is an unusual side effect, but I can't sleep if I take omeprazole. Cardiovascular risk from Vioxx was enough to pull the drug from the market; risk is also see…

IIRC Percocet is a combination of Oxycodone and Acetaminophen, so you will still be getting NSAIDS.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#87
post #36

Of course while YMMV, I've found the same thing - I've been prescribed opioids for pain, and I found that Advil worked just as well, without the side effects. I do understand that opioids have their place - for example I was told that Advil was not safe to take before surgery so I was stuck with the prescription meds. On example that made an impression on me: a couple of years ago, I had arthroscopic surgery on a kne…

> Her response was "just take the pills." There's a fairly big camp of people both online and in real life that is strongly against questioning medical authority. I've encountered it before. For example (and I know this is purely anecdotal), after doing a few hours of extensive research and photography comparisons online I came to the conclusion that my sister had shingles. I mentioned this to the doctor when I took…

After a number of years with a different diagnosis, I convinced an ultrasound technician to go beyond their exam script -- enough to discover that, in fact, I did indeed have a minor hernia.

If the doctor hadn't been so sure of his diagnosis, this would have been caught years earlier. I'd specifically asked, more than once, about the possibility.

A lot of scrambling on their part, that day, to get me a same-day appointment for consult with a well-regarded surgeon.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#88
post #86

Earlier quoted context omitted.

NSAIDS are not benign. Digestive problems are so common with long-term use that some doctors think that they should co-prescribed with omeprazole and other agents to head them off. (Long-term omepraloze will give you B-12 deficiency if you don't supplement; it is an unusual side effect, but I can't sleep if I take omeprazole. Cardiovascular risk from Vioxx was enough to pull the drug from the market; risk is also see…

IIRC Percocet is a combination of Oxycodone and Acetaminophen, so you will still be getting NSAIDS.

Acetaminophen is not anti-inflammatory this is not an NSAID.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#89
post #77
post #33

Earlier quoted context omitted.

As a migrainer, excedrin really only works part of the time. Though, opioids really only succeed in making me not care about the pain. I’m still in pain with them. The best treatments, for me, directly address whatever underlying issue.

Drifting off-topic, but have you tried sumatriptan ("Imitrex")? It seems to have a near-total effectiveness on my ~monthly migraines. Neither acetaminophen nor NSAIDs ever did anything for my migraines. I agree that directly addressing underlying causes like stress, noise, sleep, and diet are better than a pill.

I was about to say the same thing - sumatriptan works amazingly well for my migraines. I'm in the UK though, and I seem to recall someone on HN saying it was very expensive in the US.

Re: As epidemic rages, ER study finds opioids no better than Advil and Tylenol

#90
post #80

Earlier quoted context omitted.

I am not sure you actually had just Cannabis if you had those symptoms. Was this at some legal location with a proven supply chain? PS: Not to defend Cannabis, it can trigger Heart Attacks and is associated with a host of Lung issues. I just never heard of those symptoms.

Yep! I tried edibles, joints, and vape pens from 3 different dispensaries in the bay area. The edibles and "free" joint I got from Airfield Supply Co. were the ones that effected me the least negatively.

Interesting, thanks for the heads up. Though, dosage may be the issue even being around smokers can be considered a low dose.
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